A while ago, I wrote a column on the Heimlich maneuver, a well-known method to save choking victims. After the column appeared, I received an email from Peter Heimlich, the son of the late Henry Heimlich, who invented the procedure.

Peter Heimlich said that two of the methods recommended by the Heimlich Institute, which was the source for my column, are “problematic.” These are the methods for treating unconscious victims and infants. He recommended that I contact the American Heart Association and the American Red Cross and ask them for their guidelines. I felt obliged to follow-up on my column.

If you ever have to use the Heimlich Maneuver on someone who is choking, here is a basic guide from the Heimlich Institute: From behind, wrap your arms around the victim’s waist. Make a fist and place the thumb side of your fist against the victim’s upper abdomen, below the ribcage and above the navel. Grasp your fist with your other hand and press into their upper abdomen with a quick upward thrust. Do not squeeze the ribcage. Confine the force of the thrust to your hands. Repeat until object is expelled.

This method is not in question for conscious adults. Now let’s address the recommended methods for the unconscious. Here is a basic guide from the Heimlich Institute:

Place the victim on his or her back. Facing the victim, kneel astride the victim’s hips. With one of your hands on top of the other, place the heel of your bottom hand on the upper abdomen below the rib cage and above the navel. Use your body weight to press into the victim’s upper abdomen with a quick upward thrust. Repeat until object is expelled. If the victim has not recovered, proceed with CPR. The victim should see a physician immediately after rescue. Don’t slap the victim’s back. This could make matters worse.

Here is a basic guide from the American Heart Association:

For conscious victims, stand or kneel behind them and make a fist above their navel. Grasp your fist and perform abdominal thrusts using quick upward thrusts. Repeat until object comes out or victim becomes unconscious. If victim becomes unconscious, perform CPR.

Here is a basic guide from the American Red Cross: After doing the two rescue breaths twice, do five chest compressions. Look in the mouth and if there is an obstruction remove it with your index finger. The next two steps are in a continuous loop. Step 1. Now you want to do two more rescue breaths. If the chest rises congratulations! You have stopped the choking and will now need to check for a pulse and breathing. If there is no breath, do rescue breathing until the victim starts to breath again. If not go on to Step 2. Step 2. After the rescue breaths, do five chest compressions, check the mouth, and do breaths again.

Here is a basic guide from the Mayo Clinic: Lower the person on his or her back onto the floor. Clear the airway. If a blockage is visible at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Be careful not to push the food or object deeper into the airway, which can happen easily in young children. Begin cardiopulmonary resuscitation (CPR) if the object remains lodged and the person doesn’t respond after you take the above measures. The chest compressions used in CPR may dislodge the object. Remember to recheck the mouth periodically.

And now here are the techniques for infants.

Heimlich Institute: Lay the child down, face up, on a firm surface and kneel or stand at the victim’s feet, or hold infant on your lap facing away from you. Place the middle and index fingers of both your hands below his rib cage and above his navel. Press into the victim’s upper abdomen with a quick upward thrust; do not squeeze the rib cage. Be very gentle. Repeat until object is expelled. If the victim has not recovered, proceed with CPR. The victim should see a physician immediately after rescue. Don’t slap the victim’s back. This could make matters worse.

American Heart Association: Kneel or sit with the infant on your lap. Hold the infant face down, resting on your forearm. Support the infant’s head with your hand. Deliver five back slaps between the infant’s shoulder blades using the heel of your hand. Support the baby’s head and flip them over while supporting their head. Give five chest thrusts over the lower half of the breastbone. Repeat until object comes out or baby becomes unconscious. If baby becomes unconscious, start CPR.

American Red Cross: Give rescue breaths. Retilt the head and give another rescue breath. Give chest compressions. If the chest still does not rise, give 30 chest compressions. Look for and remove object if seen. Give two rescue breaths. If breaths do not make the chest rise, repeat steps. If the chest clearly rises, check for breathing. Give care based on conditions found.

Mayo Clinic: Assume a seated position and hold the infant face down on your forearm, which is resting on your thigh. Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. The combination of gravity and the back blows should release the blocking object. Hold the infant face up on your forearm with the head lower than the trunk if the above doesn’t work. Using two fingers placed at the center of the infant’s breastbone, give five quick chest compressions. Repeat the back blows and chest thrusts if breathing doesn’t resume. Call for emergency medical help.Begin infant CPR if one of these techniques opens the airway but the infant doesn’t resume breathing. If the child is older than age 1, give abdominal thrusts only. To prepare yourself for these situations, learn the Heimlich maneuver and CPR in a certified first-aid training course.

So, what to do? There are definitely conflicts in the various versions. From my experience, I have complete trust in the Mayo Clinic. If you would like to read all of the clinic’s first aid recommendations for choking, go to: mayoclinic.org

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